here comes more trouble

Clinic. The worst. Writing H&Ps even worse. New admits at two minutes before my shift is over–a dagger in my eye. But the pain is sometimes happily abated when you get a fairly straightforward (from the standpoint of medical history) patient with few medical co-morbidities.

Then I look down at the chart or an old note and see “end stage renal disease (ESRD)” and I know I’m screwed. These patients are almost always quite sick with a lot of medical problems. The reason is that people don’t typically lose their kidneys for no apparent reason. And to lose significant kidney function usually requires a lot damage–in other words, a lot of chronic systemic diseases. This usually means hypertension or diabetes. Not so fast there because long term hypertension and diabetes cause a whole host of problems from heart disease, cerebrovascular disease and peripheral vascular disease in general–all of which make medical management much more painful. Pain pain pain pain.

A patient that should be nicely and quickly tucked in becomes the dude you spend all night figuring out what to do with and then you are worrying about every second until you get your eyes on him again no matter how carefully you manage him.

Bottom line: don’t these people know that I need a break??!?!!?!? Why do they have to be so sick?